Diet taboos for targeted drugs

The first is foods high in furanocoumarins that must not be touched (grapefruit, Seville bitter orange, lime peel, etc.), the second is high calcium and high fat foods that should be staggered by more than 2 hours from the time of taking medication, and the third is alcoholic drinks and health supplements with unknown ingredients that are not recommended. In addition, most regular diets can be eaten normally. There is no need to listen to rumors such as "eating all vegetarians and avoiding fatty foods" and excessive dietary restrictions.

A while ago, I had a consultation with Mr. Zhang from the Nutrition Clinic of the Oncology Department. I met an aunt with lung adenocarcinoma who had been taking osimertinib for almost half a year. Her face was frighteningly yellow when she first entered the clinic. When she saw the test report, her albumin was only 29g/L. After questioning, she found out that she had heard from a group of patients that "Taking targeted drugs is necessary." "Avoid food, don't touch chicken, eggs, or seafood." I ate some vegetable porridge with steamed buns every day. I lost 12 pounds in three months. In the end, my immunity was so low that I couldn't even withstand the side effects of targeted drugs, so I had to stop taking the drug and use albumin to supplement my nutrition, which in vain delayed my treatment.

Let’s talk about the kind of minefield that you really shouldn’t touch in one bite. The core ingredient is furanocoumarins – it irreversibly inhibits the CYP3A4 enzyme in the liver that metabolizes targeted drugs. It is equivalent to directly blocking the metabolism channel of targeted drugs. At the least, the blood drug concentration will increase several times, causing serious side effects. At worst, it may cause drug poisoning. Don’t believe it. Last month, there was a young patient who didn’t know that grapefruit juice was added to Internet celebrity fruit tea. He drank half a cup of osimertinib at noon and took a regular dose at night. He went to the emergency department with arrhythmia that night. The blood concentration was 3.2 times the normal level. Of course, some studies believe that ordinary white pomelo and grapefruit have little inhibitory effect on enzymes and will not have much impact as long as the single consumption does not exceed 100g. However, in clinical practice, most doctors still recommend avoiding bitter citrus fruits in all categories. After all, the enzyme activity of each person is very different. Some people may have a reaction after eating one clove, so there is no need to take the risk. In addition, because star fruit contains unknown nephrotoxic ingredients, patients with poor kidney function are advised to avoid it completely.

Many people tend to generalize this strict taboo, and in the end they dare not eat anything. In fact, it is completely unnecessary. For example, the most frequently asked question is "can I drink milk?" The essence of this is that the requirement of "staggering the intake of milk" is regarded as a complete taboo. For example, if patients taking EGFR-targeted drugs such as gefitinib and erlotinib swallow the medicine right after drinking high-calcium milk or taking calcium tablets, the calcium ions will form chelates with the drug molecules, directly affecting absorption and reducing the efficacy of the medicine by at least 30%. However, as long as the time between the two is staggered by more than 2 hours, and they drink milk when they should, and take calcium supplements when they should, there is no problem at all. There are even a few targeted drugs, such as everolimus, which have very low bioavailability when taken on an empty stomach. Doctors will instead recommend that you take them with a handful of nuts or half a cup of whole milk to improve absorption efficiency. So don’t just read the list of taboos on the Internet and just take it. Ask your doctor for advice, it’s more accurate than anything else.

As for high-fat hot pot, braised pork, and particularly spicy iced foods, they are not completely off-limits. However, if you take targeted drugs, you will have side effects of nausea, diarrhea, and oral ulcers. If you insist on showing off spicy crayfish and iced milk tea, you are simply asking for trouble. I once saw a young man in his 20s who secretly ordered three kilograms of spicy crayfish while his family wasn't paying attention. He vomited the medicine twice after eating it for two days and had a bowel movement. During the reexamination, the blood concentration of the medicine fluctuated so much that the doctor almost adjusted his dosage. Why bother? If your gastrointestinal tolerance is good, eating a slightly spicy bite to satisfy your cravings occasionally will have no impact at all.

As for the most popular "food taboos" that cannot be eaten, such as chicken, eggs, beef, mutton, and seafood, it is really nonsense. There is currently no evidence-based medical evidence to prove that these so-called hair products will affect the efficacy of targeted drugs. On the contrary, these are the main sources of high-quality protein. During the period of taking targeted drugs, the body consumes much more than ordinary people. Sufficient protein can withstand the side effects and maintain immunity. If you really avoid them all, you will be malnourished like the aunt before, but it will hinder the treatment. Of course, if you are allergic to seafood, you definitely cannot eat it. This is a matter of personal constitution and has nothing to do with targeted drugs.

The last thing I want to remind you is not to buy health care products indiscriminately. Internet celebrity anti-cancer Ganoderma spore powder and imported ginsenosides have unknown ingredients and can even induce abnormal liver enzyme activity. Either the targeted drugs will be metabolized too fast and have no effect, or the metabolism will be too slow and cause problems. There was a patient who secretly took the Internet celebrity's "anti-cancer miracle product" for three months. During the reexamination, his liver enzymes soared to five times the normal level. He had to stop the targeted drug to protect his liver, which was not worth the loss. If you really want to supplement your nutrition, take your health care products to your attending physician and nutritionist to make sure there is no conflict before taking them. Don’t waste money and harm yourself.

In fact, after practicing clinical nutrition for so long, I always feel that there are not so many rules and regulations for the diet of taking targeted drugs. The core is to "preserve nutrition first, and then avoid risks." Don't hold your mobile phone every day to check "can you eat this, can you eat that?", and you will be so anxious that you can't eat well. A balanced mix of home-cooked meals, more fresh vegetables, fruits, and high-quality protein are better than any taboos. If you are really greedy and want to eat something, as long as it is not something that is absolutely taboo like grapefruit, a small bite will not make the world collapse. A good mood will help the effect of the medicine much more than eating a few bites is a taboo.